Aortogram with left lower extremity runoff. BL common femoral artery cannulation


Marlton, NJ
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Self teaching myself Vascular coding - please help!
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Aortogram with left lower extremity runoff. Bilateral common femoral artery cannulation.
General Procedure
Type of procedure: angiogram.

Anesthesia Information
Anesthesia: 1% xylocaine.
Anesthesia method: general, local lidocaine.
Procedure Description
Estimated Blood Loss: Nil.
Drains: Not applicable.
Specimens Removed: Not applicable.
Complications: No complications.
Aorta: large pararenal aneurysm, extends from above renals to bifurcation.
Iliacs: b/l iliac arteries patent, with profound plaque burden. Severe tortuosity of iliac vessels. No significant stenosis noted.
Right CFA: profound plaque burden, w/o evidence of stenosis.
Left CFA: profound plaque burden, w/o evidence of stenosis. SFA occluded at origin. PFA patent, with robust collateralization to reconstituted popliteal. Left Popliteal: patent below knee
Tibial vessels: Anterior tibial occluded at its origin, tibial-peroneal occluded at origin, possibly severe stenosis - somewhat limited imaging due to attempt to limit contrast, , immediate proximal reconstitution of peroneal artery continuous to ankle, with reconstitution of atretic dorsalis pedis which does not form arch. Posterior tibial is robust and continuous to foot. .

Patietn borught to operative suite, placed supine, cleaned prepped and drapped in standard sterile fashion. Microintroducer sheath used to cannulate right CFA. Sheath angio performed to ensure proper cannulation level - insured. Benston wire placed, 5 Fr sheath placed. Pigtail placed, aortogram performed. An attempt was made using a VCF catheter and glidewire was used in attempt to cannulate the left CFA. Due to torusoity cannulation was unsuccessful. Therefore the left CFA was successfully cannulated again with the microintroducer. Diagnostic angiogram was then performed of the left lower extremity - please see findings. The right groin was again prepped and a 6Fr Angioseal was deplyed in the right CFA, as the patient will require immediate post procedure heparinization for recent PE. Pt was given a bolus of 5,000 units of heparin for this case. ACT measured at case end was 215s. The microintroducer sheath was removed from the left CFA and firm pressure was applied for 20 minutes. The pt received a total of 32cc of Visipaque contrast for this case.

Pt will need to be considered for surgical bypass for limb salvage